42 Responses to “Saturday Afternoon Links”

Regarding the amputee being harassed by TSA, I was not aware that amputees view exposing their stumps (sorry, is there a more gentle term?) the same way as exposing their genetals. Nor was I aware of aputee porn. In my work as a photographer for American Legion, I have photographed many wounded warrior amputees showing their injuries who exhibited no shyness about being photographed. Regardless of that, I am in no way defending TSA. They are the reason I no longer fly if any other means are possible.

For the record I have no problem with people cutting off stuff once they are adults. But slicing of parts of kids because you don’t like the look as their parent? Surely that is about not libertarian as it gets? No?

This one a case were thinking of the children is actually the libertarian way to go forward, please think of the children?

Thanks, notaviking, for making the point of how objectionable unnecessary surgery like this on children is.

From what little I know from op-eds, tv shows etc., most adults who were operated on as children would much rather have been left alone and not subjected to totally unnecessary surgery. Even worse are surgical sexual assignments (male/female) when one doesn’t yet know how the child later in life will want to live. All doctors need to tell worried parents (who are obsessively examining their child’s genitals?) is “it’s a bit large, as an adult/teenager with informed consent, surgery may be appropriate, but it’s too early and wrong to do so now”.

The surgery reportedly leaves many enjoying sex less, or not at all, and many are unable to have orgasms. If anything, people need to be more offended by this.

In re: TSA. A coworker was held up by two TSA goons (aged 17 and 18, if you can believe it – the 18 yo was the supervisor!). The problem? His license read with his first, middle initial, and last name. His ticket read with his middle name (which he goes by) and his last name.

They didn’t believe that the initial corresponded with his name.

They asked if he had another government ID and he said, what, like the CIA? This is my driver’s license! What other government-issued ID do I need for domestic travel?!?

Also, I’d probably be a dead woman. If I saw anyone touching my little boys like that, preventing them from coming to me for aid and comfort, my motherbear instincts would come out full-force and… I’d be a dead woman.

The day someone can talk about their objections to surgery on girls’ genitals without an immediate comment about male infant circumcision is the day we achieve the millennium.

Also – about the name on the ticket: This is not new, uncommon, or even necessarily TSA’s innovation. You get the ticket in the name on your ID. Otherwise you risk not being able to fly. If the guy had his full middle name on the ID maybe an initial, middle name, last name would be reasonable, but booking a flight in a name that appears nowhere on his ID was, let us say, ignorant.

ktc2 – Actually, yes, that is the point that opponents of routine infant circumcision have been making for a while. Given that you can’t do anything to a child without their ability to consent barring an immediate medical need (therefore allowing vaccination and medically necessary surgery), there’s a lot of cognitive dissonance in this country surrounding male circumcision. Our culture really wants to find a reason to keep doing it but again and again finds that studies showing benefits are compromised or at least don’t outweigh the risks (far more babies die each year from circumcision complications than died in any of the recent crib recalls, and they die in greater numbers than men do from penile cancer which is a commonly cited though unfounded reason for circumcision, if you want some perspective). Pretty much every major medical establishment considers it cosmetic surgery, which means that we are allowing parents to override their children’s bodily autonomy and modify the function of their genitals for cosmetic reasons – which would horrify anyone if it were done to girls’ genitals, or if people were cutting off earlobes or Chinese footbinding etc. I consider overriding parental choice in this matter to be completely in line with libertarian ideals. Check out http://www.intactamerica.org/ for more info – they focus on male circumcision in the US mainly but also oppose FGM and intersex surgery on minors. There’s also a good Penn & Teller: Bullshit episode debunking circumcision myths.

One other quick thing – I’m not surprised some people are offended by conflating male circumcision with FGM and intersex surgery, it happens nearly every time there’s any discourse on the issue of genital surgery on children. Particularly given that I would guess that the readership of this blog swings heavily male, born during the highest circumcising years of the 60s and 70s. If you’re interested in getting a perspective on genital surgery of all kinds that is written with that in mind, check out this author’s blog post: http://www.adriancolesberry.com/life/?p=554
He also has a lot of other posts that frame anti-circumcision arguments in a very sex-positive, pro-individual-autonomy way. I can’t blame anyone for not wanting to hear that their genital alteration was unnecessary, which is where I think some anti-circumcision activists lose a lot of potential supporters – but reframing the argument to “your circumcised sex life can be awesome but still shouldn’t be an argument for cosmetic genital surgery on babies” helps.

Cosmetic surgery on young children’s genitals is a bad idea. Period. We can debate where to draw the line where people should be able to consent(12? 18?), but risking death or permanent loss of sexual function to match a cultural norm is misguided. If we banned circumcision, uncircumcised people would not be weird. Intersexed (not sure if that is the right term) children would probably still stand out given the rarity of the condition, but they should be able to choose what to do.

I was circumcised without being given a choice, my kids will have one. I’m not bitter and don’t feel emasculated, I just don’t think it’s my decision to make.

The bottom line of Dr. Poppas’ study is that its indefensible and the “hysteria” hasn’t really been debunked because the Slate article missed the point. The surgeries were done on children without the ability to consent and will full knowledge that there was a good chance some kind of sensation could be lost. They had no medical necessity and were essentially cosmetic. In many cases they were “corrections” performed on intersex children, procedures whose sole purpose was to make the children appear more normal. There is no medical reason why these surgeries had to be done at birth and couldn’t have been held off until the children in question had reached the age of consent. That would be enough for Poppas’ work to be indefensible, and its the macro-level problem involving how our society sees intersex individuals, the rights of children, and the incredible power we give doctors to “fix” people without consent.

The micro level problem, though, is that what Dr. Poppas did really does skirt the line of child molestation. Was he looking for an answer to a scientific question? Sure, but thats not really the objection. The objection is to his methodology and his practices. Generally with these kinds of sensitive follow up procedures which do not require medical expertise a reasonable researcher would have female nurses/techs do the actual stimulation. You would also likely design a procedure that was less likely to be sexually stimulating. Finally you would properly contextualize the follow-up by having it done in a doctor’s office like a normal gynecological exam. Dr. Poppas didn’t take any of these steps. He went to the homes of these children, performed the manipulations himself, and used a device likely to be highly sexually stimulating. He did this yearly with children starting at 6. This is especially problematic because this isn’t the first time such research has been conducted and there exists a significant body of literature which suggests that these kinds of follow-ups can be highly traumatizing for the children on whom they are performed.

Dr. Poppas could have avoided much of the criticism he has faced had he gone to Cornell’s IRB and worked a little harder to design a study that respected his patients. He didn’t because, like many doctors, he felt that he was right and didn’t want to be bothered with the pain in the ass.

William,
This is not the case of “inter-sex” children! They are all little girls. And as far as the testing goes…Would you rather that the doctor just do what everyone else does and repair the abnormality cosmetically, not worrying about its function, in the end?

As I posted on Slate….

“The entire argument, against getting the surgery done early, is disagreeable to me. The ignorance of most of the posters on here is dangerous. Ever hear “a little knowledge can be dangerous”?

Congenital adrenal hyperplasia is the result of a lack of enzymes that normally convert certain chemicals in the adrenal cortex, to the needed hormones. This results in the cortisol, as well as the sex hormones, being abnormal (some high, some low). The result is abnormal genital over-growth in the affected female infants. The procedure to correct it has nothing to do with “genital mutilation”, as practiced by other societies!

Since when is this “inter-sex” surgery? It is not. It is a female with an enlarged genitalia. Do you people, that disagree with early surgery, forget how mean other children are? If your daughter has an abnormal genitalia due to this condition, they are going to receive bullying and ridicule in the girl’s locker room at school or the pubic pool!

The testing, post-op, was to help determine which procedure performed would give the best results in maintaining a normal organ! (All though, this testing, like most, is not perfect, as yet. It is, still, the best we have!) Should we ignore the science to appease a few ignorant people who don’t know the difference? Doing the procedure before the child has any knowledge of the abnormality sounds best to me, Libertarian or not.

And why don’t you look up the pictures I found on “All the Web” when I searched for this condition. I would never let my little girl go through life with a deformity that would cause her heartache, when all the “normal” little girls saw it, and started teasing her!

Most of you have too little education and knowledge to be second guessing a board certified pediatric urological surgeon! He is not unethical. He would be if he let public opinion effect good medicine!”

I know many will, likely, not enjoy my post. But, should we allow the girls to go through life with this added self esteem killer? My answer would be FIX IT!!!

-Michael, your use of these terms are why I don’t take your post seriously. There is no medical definition of a “normal” size for a clitoris. There is a range. Surgically altering children who are too young to consent to fit someone’s arbitrary definition of normal is a bad idea.

As for your claim that “He is not unethical”, his failure to consult with the IRB is proof positive that you are wrong. Any research with human subjects requires IRB approval.

Current school procedures (unlike those most adults grew up with, communal showers, etc) make it incredibly unlikely that any child will HAVE to disrobe in front of friends. Particularly one so young (pre-high school) that they can’t wait to get to an age that they can consent to their own body being modified.

Fix the bullying if it’s a problem, don’t put small children through genital reduction surgery.

The clitoroplasty makes me sick. The Slate article makes it quite clear that this surgery is COSMETIC in nature. We’re talking about the deliberate cutting off of clitoral nerve tissue that is, aside from “cosmetic” issues, perfectly healthy and functional. It’s revealing precisely what this says about our culture. I note that I am equally opposed to circumcision, as I am to all non-medically necessary invasive surgery of infants and children.

But note the double standard – although our culture does largely accept circumcision, we would never routinely take a knife to male sexual organs because they are perceived as “too large.” Large penises are celebrated. Large clitorises are not. If you accept mainstream hetero pornography as indicative of large trends within our culture, it’s difficult to find women with clitorises that are larger but still well within the range of “normal.” It’s part of the women that clitoral hood reductions is an increasingly popular form of plastic surgery. If adults want to mutilate their body to conform to our fucked up sexual ideals, that’s one thing. But to do it to infants is disgusting.

Damn, I actually had to be honest and give ClassAction a plus on that one. Felt weird since we tend to strongly disagree a lot. :)

Infants should be given the time to grow up and make the choice themselves. The argument about other kids bullying them is really an argument in favor of giving them privacy instead of making them shower together. The other kids should never have the chance to know about anything that is a little (or even a lot) out of the “normal” range.

Michael, I see that you’re fond of taking shots at the education and knowledge of others as a means of obfuscating a basically paternalistic and emotional argument. Suffice to say my credentials are in order both in discussing gender issues and in discussing professional ethics. I am not, however, so insecure as to attempt to foil disagreement by waving the magical power of a name followed by post-graduate letters.

As other posters have mentioned the need for children to disrobe in front of one another is increasingly unlikely. Even if that were not the case, the vile behaviors of a majority are not an excuse for ignoring the rights of a minority. The problem of bullying lies in the bullies, not in the children who are bullied. To perform surgery on someone that is not medically necessary (trimming down the clitoral shaft only treats a symptom of CAH, afterall, and a strictly cosmetic one at that) and without their consent is indefensible. There is no reason that the surgery couldn’t be put off until the person upon whom it will be performed is able to make a reasoned and informed decision about it.

As to your point about ethics, I have noticed that you ignored my comments about methodology and the problematic absence of IRB oversight (which, while not strictly mandated, is best practices for human subject research) in this case. Instead you resorted to an “if your daughter…look at these shocking photos” comment and dressed it as an argument. It is unfortunate that you feel so threatened by someone challenging your perceived authority that you are unable to effectively engage with others.

Finally, there are your comments about these children being female, abnormal, and there being no relation to the genital mutilation of other cultures. While that might appear to be accurate at a glance, your assertion breaks down under more direct observation. The line between male and female is not well demarcated at the best of times and has become increasingly blurred by the presence of the modern Trans* activist movement and open intersex individuals. Saying that these children were simply “abnormal females” is not fact but rather an opinion based in a particular system of values and beliefs about taxonomy and how things like sex and gender ought to be determined, defined, regulated, and controlled. In short, you’re moving outside of medicine and into the realm of philosophy and gender theory, one in which empiricism and logical positivism does not hold authority.

That brings us to the second problem with your assertion: the relationship between these kinds of “corrective” surgeries and the horrific genital mutilations practiced in some cultures. While it is true that what the children in Dr. Poppas’ study experienced is not as physically (or, probably, even psychologically) traumatic as “the cutting of the rose,” that is a difference rooted more in technique then in meaning. See, the reason some cultures engage in genital mutilation is to control and regulate the roles and behaviors of men and women. It enforces a certain cultural norm and expectation, it seeks to dictate the ways in which men and women relate to one another and the kinds and context of sexual behaviors. Dr. Poppas’ clitoroplasties might be more humane and the culture he is enforcing might be different (even better) but the fundamental meaning behind his procedure is the same: he seeks to make women into what women should be, for their own good and without bothering to obtain something so messy as consent. He is enforcing a normative ideal.

You know whose opinion matters more than yours, or mine, or any other doctor’s? That of adults with this condition who were operated upon as children or teenagers and who consider what was done to them vile.

Not only the operation that in many cases left them unable/less able to enjoy sex, but the continual interventions that traumatized them as they would have been with any other form of child abuse.

There are cases such as facial deformities when I agree that the trauma of other children’s reactions may warrant earlier medical intervention. What’s in someone’s underwear is not one of those situations – and even if it were, to take your example, locker rooms are not something that an infant has to worry about, wait until later in life (a teenager would be better able to provide input as to her wishes).

Should we stop the practice of correcting cleft palates? Let’s be honest… how much of our objection to this surgery is based on it being a cosmetic surgery chosen by the doctors/parents and how much is based on it having to do with little girls’ vaginae and the general ickiness and prudeness with which we approach such topics?

I’ll be honest, I don’t know enough about the facts in this case to say exactly how appropriate this surgery is. BUT, let’s make sure we are letting reason dictate our responses and not emotion. Ask yourself if you would have the same objection if the surgery didn’t involve *GASP* private parts!

#32 – I think the big difference is that cleft palates (and even the milder cleft lips) cause significant issues to children’s development. Many can’t breastfeed, some can’t even bottlefeed, many have speech development problems. Regarding the social issues – having a clitoris that is larger than usual, being intersexed, or having a foreskin is not something that affects your development. It is also not something that is out in the open. No one but the people helping the kid with diapers and baths are going to be focused on it. A facial deformity is something completely different from having genitals that are not exactly the same as everyone else in the overarching culture (though at least with male circumcision, rates have dropped to close to 50/50, so really the locker room argument is especially silly when there’s not even a clear majority in their peer group), and is something that could cause consistent social problems.

The only commenter, that had this surgery, I saw on the original site, felt it was appropriate. She stated it was done before she even could remember.

The procedure of stimulating the clitoris was to help ensure that future fixes for this deformity would be the best to perform, resulting in the best function, as well as appearance. (I think he, actually, he was trying to modify the surgical procedure as to maintain normal function (maximize sensation?), avoiding the,exact, sexual dysfunction you were referring to.)

I had no idea that the locker rooms were, now, much better than when I was a kid. I remember showering in a, fifteen stall, open shower. And, I was bullied for being fat. But, then again, that ages me.

And I have to admit, being a small town boy, leaves my personal sophistication to be lacking as compared to the more sophisticated surroundings of academia.

I did not understand so much as to what the IRB had to approve here. If the stimulation was an unacceptable part of the procedure, why did it seem that the parents had no problem with investigating the success of the surgery. Just seems like common sense to try to check out the success of the procedure. If the investigational process needed to be fixed, then I agree, then it should be done properly, through the IRB.

Never having been in such a situation, I can only speculate that I would have the procedure done early, if it were my own daughter. And, as you state that is not the same decision as you would make for taking out a hot appendix. It does involve other concepts than, just, the surgical procedure alone. But, being the victim of bullying, leaves one with altered states of mind. And, sad to say, our society notices differences in appearance associated with deformities, amputation, extra digits, etc. in a bad way. Hell, our society emphasizes the differences in races and uses that to abuse others, not like us. Society, in this instance, is lacking. But, I doubt we will easily fix this problem.

No matter what you say or how eloquently you say it, to think that a physician who is trying to help restore normal appearance and function, is being portrayed as a sexual predator, (the way I see it, anyway) is sad.

And I love it how MD’s are not really that smart now, are they? Especially, a pediatric urologist, who has to undergo, likely, an extra four to six years in surgical training (compared to general surgeons)to attain such a designation in specialty. He should have been able to avoid this controversy if he was truly intelligent. Or, maybe he was not as well trained in doing proper paperwork for his research. All of his training must have been centered around the surgical procedures and little of it around the research protocols needed. Nobody’s perfect!

The only commenter, that had this surgery, I saw on the original site, felt it was appropriate. She stated it was done before she even could remember. I remember nothing being said about her function.

If I understand correctly, as often quoted by my wife, 60% of women are unable to have orgasm with sexual intercourse, to begin with. What kind of dysfunction are they referring to? This is not vaginal surgery, as one of other commenters suggested. There should be no interference with normal sexual intercourse, or vaginal penetration, afterward. Again, I don’t know what dysfunction is being referred to.

This doctors is trying to perfect a procedure that preserves the function and maximizes clitoral sensitivity. (still has no way of guaranteeing orgasm with intercourse) Do you suggest that this doctor should not try to improve the procedure? Who will it hurt to wait? Only the child. Maybe they should just outlaw the procedure and let them fend for themselves until they are abnormal adults. And, as stated by others, this is an emotionally charged issue. We could say the same thing about correcting hypospadias or ectopic bladder, or other genital deformities because they are hidden by the child’s clothing. I don’t see it as being a simple decision.

Nobody (here) that I’ve seen is saying the Doctor is a sexual predator. Most people seem to be saying the same thing: that it’s wrong to perform cosmetic surgery on babies or young children that mutilates otherwise perfectly functional sexual organs. It’s a clearly articulated, principled stance rooted in common sense notions of bodily integrity. If you want to address this issue, I’d be happy to hear it. If you’re going to attack straw men like “the doctor is a pervert!” or “doctors are stupid!” well, why bother having a conversation at all?

RE: Lightning. I’m a little upset with lightning right now. My parents’ house was struck by lightning yesterday, and blasted chunks out of the wall of my old bedroom. Fortunately, I haven’t inhabited it for quite some time, but still, I’d appreciate it if Mother Nature would refrain from trying to set fire to what remaining stuff I still have in that room (which I believe consists entirely of one drawer full of old concert t-shirts and posters, and about a shelf’s worth of books).